PurposeSepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.MethodsThe study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38 °C or lower than 36 °C, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.ResultsAmong the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788–0.963) as compared with 0.75 (0.634–0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.ConclusionSPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore...

No abstract

Introduction: Pediatric Emergency Care Applied Research Network (PECARN) is the best accurately identify children at very low risk of clinically important traumatic brain injuries (ciTBIs) in the Emergency Department (ED). Therefore, the implementation of evidence-based tools for clinical decision-making in the acute care setting has shown to improve quality of care as well as patients’ outcomes. This study aimed to assess the PECARN on quality of care in mild head injury children after improving competency of emergency physician. Methods: The study is a cross-sectional, prospective study included 50 Children with mild head trauma attending to the Emergency Department (ED) of the Suez Canal university Hospitals. Patients divided into two groups according to their age (less or more than 2 years). We used the Statistical Package of Social Science (SPSS) program version 20 for data analysis. Results: The most common cause of injury was direct head trauma, followed by motor car accidents and the least frequent injuries were due to fall from height. Our results regarding the adherence of residents to the PECARN CDR demonstrated that the residents were adherent largely to the rule with a level of adherence of about 92%. Conclusion: the adherence of the emergency department physicians in SCUH to the PECARN CDR while managing pediatric mild TBI. PECARN proved its effectiveness as a clinically predictive tool to understand who can safely avoid a cranial CT scan after TBI and the risk stratification provided by it was significantly associated with positive CT scan findings. Keywords: Pediatric care; Mild head injuries; Traumatic brain injuries

Background:The main cause of death globally is acute myocardial infarction (AMI), specifically acute coronary syndrome (ACS). In the setting of acute myocardial infarction, right ventricular (RV) infarction has a greater risk of adverse outcomes. Objective: The goal of this study was to evaluate the right ventricular function in patients with an acute anterior myocardial infarction. Patients and methods: This case control study included 60 participants who were divided into two groups; group 1 included 30 patients with acute anterior myocardial infarction (first attack and within 1-12 hours of symptoms onset), and group 2 (control group) included 30 age and gender matched group with no MI. All patients with acute anterior MI were managed by primary percutaneous coronary intervention (PCI). Results: Compared to control group, we found that the mean RIMP was significantly higher in the MI group (0.50 ± 0.081 vs 0.28 ± 0.043, p < 0.001), mean TAPSE was significantly lower in the MI group (1.76 ± 0.391 cm vs 2.38 ± 0.420 cm, p ˂ 0.001), mean fractional area change was significantly lower in the MI group (32.34 ± 3.625 % vs 48.00 ± 5.350 %, p ˂ 0.001), mean DTI-derived tricuspid lateral annular systolic velocity was significantly lower in the MI group (11.091 ± 2.0334 cm/s vs 13.077 ± 3.0285 cm/s, p= 0.014), and mean right ventricle strain was significantly lower in the MI group (-16.47 ± 3.246 vs -26.83 ± 2.276, p ˂ 0.001). Conclusion: Echocardiographic RV function parameters are significantly lower in the setting of acute anterior MI compared to controls denoting more RV dysfunction among this group of patients.